ArticleFunctional Performance of Preterm Children at Age 4
Section snippets
Purpose
In this study, we examine functional performance as an outcome and explore its relationships with health and motor outcomes for preschool preterm children born with varying birth weights and perinatal morbidities. We test the effect of perinatal morbidity (birth weight and neonatal illness) and preschool (age 4) health and motor development on functional performance. We hypothesize that preterm children with medical and/or neurological neonatal illness will have poorer functional performance
Literature Review
Low birth weight has adverse consequences for health and functional outcomes, and evidence shows that the percentage of children with functional limitations may be increasing (Hack et al., 2000, Vohr & Msall, 1997). Birth weight is the common predictor in preterm follow-up studies where decreasing birth weight is associated with more developmental sequelae, such that the smallest babies are likely to have later problems (Aylward, 2002a). However, not all extremely low birth weight (ELBW; <1,000
Theoretical Framework
The theoretical model for the study is derived from the bioecological model of development (Bronfenbrenner & Morris, 1998). In this model, the biopsychological organism represents the newborn infant who may have experienced prematurity and perinatal morbidity (medical illness, neurological illness, or both). The experiences of the preterm infant during the neonatal period are influenced by the processes that occur in the immediate environment called proximal processes. In turn, what happens in
Sample
The sample of 155 children, born between April 1996 and March 1999, was enrolled into one of four a priori perinatal groups according to neonatal illness and birth weight: 41 preterm infants with birth weight <1,000 g and medical illness (BPD, respiratory distress syndrome, necrotizing enterocolitis, sepsis; medical preterm group 1 [MPT1]); 39 preterm infants with birth weight ≥1,000 g and medical illness (medical preterm group 2 [MPT2]); 32 preterm infants with severe neurological illness
Results
Correlations across preschool measures of functional performance and motor scores were moderate in effect (total functional performance and motor: r = .58, p = .0001; total functional performance and visual motor integration: r = .57, p = .0001; general motor and visual motor integration: r = .55; p = .0001). Correlations of functional performance and motor scores with health status were negative, small in effect, but significant (total functional performance: r = −.21, p = .01; general motor: r
Discussion
We found moderate correlations between functional performance, health status, and motor scores. These interrelationships suggest that lower functional performance is associated with poorer motor performance and less optimal (suspect or abnormal) health status. Developmentally, a 4-year-old is expected to perform most self-care tasks with minimal assistance, such as self-toileting, dressing both upper and lower body, and hand washing. The child should also have acquired salient preschool skills
Acknowledgments
This work was supported by NIH Grant NICHD RO3 37627.
The authors wish to thank Sharon Capuano, MS, RNP, Maribeth Walesko, MS, RNP; Christina Poore, MS, RNP; Melissa MacNeill, MA; and Katheleen Hawes, MS, RN, CS, for their assistance with the home visits and data collection.
References (41)
Validating measures of pediatric health status, functional status, and health-related quality of life: Key methodological challenges and strategies
Ambulatory Pediatrics
(2004)- et al.
Outcomes of children of extremely low birthweight and gestational age in the 1990's
Early Human Development
(1999) - et al.
Content validity of a pediatric functional independence measure
Applied Nursing Research
(1990) - et al.
Interrater agreement and stability on the Functional Independence Measure for Children (WeeFIM): Use in children with developmental disabilities
Archives of Physical Medicine and Rehabilitation
(1997) - et al.
The WeeFIM instrument: Its utility in detecting change in children with developmental disabilities
Archives of Physical Medicine and Rehabilitation
(2000) - et al.
Incidence and evaluation of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm
Journal of Pediatrics
(1978) - et al.
Comprehensive assessment of the health status of extremely low birth weight children at eight years of age
Journal of Pediatrics
(1994) - et al.
Neuropsychological and functional outcomes of very low birth weight infants
Seminars in Perinatology
(1997) Methodological issues in outcomes studies of at-risk infants
Journal of Pediatric Psychology
(2002)Cognitive and neuropsychological outcomes: More than IQ scores
Mental Retardation and Developmental Disabilities Research Reviews
(2002)
Neurodevelopmental outcomes of infants born prematurely
Journal of Developmental and Behavioral Pediatrics
The Beery–Buktenica developmental test of visual–motor integration
Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birth weight children at 12 years
Journal of Child Psychology and Psychiatry
Impact of the infant health and development program (IHDP) on the home environments of infants born prematurely and with low birthweight
Journal of Educational Psychology
Nature–nurture reconceptualized in developmental perspective: A bioecological model
Psychological Review
The ecology of developmental processes
Statistical power analysis for the behavioral sciences
Possible strategies to protect the preterm brain against the fetal inflammatory response
Developmental Medicine and Child Neurology Supplement
Functional limitations and special health care needs of 10- to 14-year old children weighing less than 750 grams at birth
Pediatrics
Four factor index of social status
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